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Preventing Childhood Injury. Your name, etc. . Our injury burden. High severity Lower severity. Low numbers High numbers. Deaths . Emergency admissions (2007). Attendances at emergency departments. Minor injuries treated at Health Centres and GP surgeries or at home. References
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Preventing Childhood Injury Your name, etc.
Our injury burden High severity Lower severity Low numbers High numbers Deaths Emergency admissions(2007) Attendances at emergency departments Minor injuries treated at Health Centres and GP surgeries or at home References Injury pyramid: BMA (2001) Injury Prevention Very minor (often untreated) injuries
“Injuries do not occur by chance. They are largely 1. preventable, non-random events, and not “accidents”. 2. Certain groups of people with certain characteristics are more likely to be injured. By studying how injuries 3. vary within a population, we can begin to gain an 4. understanding of the factors that lead to injury, and how the 5. risk of injury may be reduced”.Injury Prevention, British Medical Association, 2001
“1..preventable...not “accidents” No cause? Unexpected? • Four-year-old dies after a tragic accident “(Exodus Tyson’s) seven-year-old brother found her hanging from a cord which was dangling from a treadmill in their home in Phoenix, Arizona”. • Brothers meet tragic end on Snowdon “They died after slipping and falling up to 300m from an accident blackspot at a craggy area on the mountain's west side, Clogwyn Coch, at the weekend”. • Ealing boy dies after air rifle tragedy He died in a “tragic accident”, after being left playing with other 10 year olds and a loaded air rifle. • Tragic accident as farmer crushed by sheepdog in tractor “Harry Emslie, 67, left the border collie in the cab of a telescopic loader with the engine still running - and the handbrake off”. “an unforeseen event or one without an apparent cause” Collins English Dictionary
Group activity • What caused these injuries? • Were they predictable? • What would have prevented them?
“2...certain groups of people....” • Children up to the age of 15 years from unskilled families are 5 times more likely to die from unintentional injury than those from professional families • Children up to age 15 years from unskilled families are 15 times more likely to die in a fire in the home than those from professional families Our Healthier Nation, 1999 Injury death rates in children 0-15 by social class. (BMA, 2001.)
“2...certain groups of people...” • Children of single parents – (40% to 50% higher injury rate than two-parent equivalents. Overpeck, et. al. (1997), Roberts I (1994), Wadsworth et al (1993)). • Caregiver alcohol/ drug consumption (Damaschek et al (2009), Bijur et al., (1992)). • Children living in rented accommodation (Kendrick. D, (2005), NICE, (2010)). • Unemployed parents (9x higher death rate than parents in highest income occupations. Sethi, D, et al (2008)) • Learning difficulties & Mental Health problems
Families vs neighbourhoods “The greater variation in injury rates vary between families than between neighbourhoods suggests reducing inequalities in injury rates may be achieved more effectively by focussing prevention at families rather than neighbourhoods, but in practice interventions at both levels are likely to be necessary”. Relationships between child, family and neighbourhood characteristics and childhood injury: a cohort study. Kendrick D, Mulvaney C, Burton P, Watson M. Soc Sci Med. 2005 Nov;61(9):1905-15. Or in other words Social, family and domestic circumstances are as important as neighbourhood characteristics like housing type and road layout as factors influencing overall rate of childhood injury. Some families in deprived areas have relatively low rates of injury.
Group activity Describe thefamily with the highest risk of serious childhood injury. List the factors you would expect to see in the worst case scenario, considering the family, their home, neighbourhood and the public services they use.
“5(a)...reducing risk. Working with partners. Services • Retailers stock home safety equipment provision • Daycare providers trained in injury prevention • Trading standards engaged with checks of limitations of supply (painkillers) and safety testing of toys and other products • Daycare sufficiency assessments – so parents can take a break • Information provision by service providers • Health visiting team, fire and rescue services, etc trained in prevention Environment / neighbourhood • Housing providers (fire alarms, TMVs, maintenance) • Speed limits, junction engineering, enforcement, vehicle separation • Enhance employment and training opportunities to tackle economic deprivation • Suitable provision of safe play areas
“5(b)...reducing risk. Working with families. Improve Supervision/reduce social isolation Home improvements – “Childproofing” Raise Awareness of injury hazards Create Routines and rules (and reminders and repetition!) SCAR, CRASs, All Children Should dReam
Burns and scalds – Causes • Hot drinks • Hot food • Bathwater • Hair straighteners / irons Hot water burns like fire
Burns and Scalds - Prevention • Raise awareness No. 1 cause = Hot drinks. • Create routines and rules Keep children and hot drinks apart. • Childproofing Use heat resistant bags for hair straighteners Most burns and scalds happen in the kitchen. Use a playpen, or keep children out.
Accidental poisoning - Causes 1. Common painkillers and cold remedies are the single biggest cause of serious childhood poisoning. 2. Things not put away in their safe place. 3. Batteries, coins, small toys, pins, keys and other small objects are left where small children can reach them.
Accidental poisoning - Prevention Safe storage, straight away
Accidental poisoning - Prevention • Tidy up. • Lock away above head height. (Treat all pills, medicines, liquid painkillers and cold remedies like prescription medicines). • Straight away. Health visitors in Nottingham found poisoning happens when things are left out because they are still in use, or “will be put away later”).
Home fire safety Avon Fire and Rescue – Free Home Fire Safety Checks Tel: 0117 9262061
Falls in under 5’s - Causes • Stairs and steps • Falling from furniture (sofas) • Falling from beds when having nappies changed • Baby walkers • Climbing (floor – furniture- windowsills, curtains, bookshelves, cupboards)
Falls in under 5’s - Prevention • Awareness Falls are the largest cause of childhood injury • Childproofing Use stair gates, break climbing routes by moving furniture • Rules No (stair) climbing without a parent • Supervision Use the children’s centre / friends so you can take a break!
Low numbers, high profile injuries • Firework injuries – Follow the Firework Code • Blind cord strangulation – keeping cords, chains, and tapes and similar out of the reach of children. • Drowning – never leave babies alone in the bathroom. Children need to learn to swim.
Group activity What can we do to reduce injury? (Refer back to family and neighbourhood level intervention slides for ideas) • What injury will you focus on? • Who will you target? Where? • How will you reach the target group? • What will you do? • How will you monitor / evaluate?
Further information Avonsafe www.tinyurl.com\avonsafe RoSPA www.rospa.com Child Accident Prevention Trust www.capt.org.uk
